NUR 700 Discussion 7.1: Theory, Practice, and Philosophy of Nursing

I interpret the statement “Theory must be a guide to practice, not an end in itself” to mean that theory is the basis for making sound clinical judgments and not just a historical manifestation. This means that in nursing, even today, we should be studying an assortment of theories and utilizing them as a basis to sculpt nursing practice (Saleh, 2018). Understanding nursing theory is only the beginning because when theory is implemented into practice, that is truly when nursing can expand and progress, thus meaning it is not an end. Theory offers the framework that differentiates nursing practice from other disciplines and directs how nurses interact with patients and view each health circumstance (Saleh, 2018). High-quality nursing practice involves the application of knowledge, skills, caring, and art to care for patients in a successful, competent, and respectful way (McEwen, 2014). This all stems from nursing theory.

My personal nursing philosophy has not changed since the beginning of class. It has only adapted and become stronger. My tenets of integrity, knowledge, and empathy remain the same. I still believe that in order to be a good, strong nurse, I must treat my patients using the knowledge I have obtained from up-to-date evidence-based practice which is also backed by nursing theories. I must also perform all tasks and duties with the utmost integrity. Lastly, I must place myself in my patients’ shoes so that I can better understand them and their feelings. However, I now have a better understanding of different nursing theories, which work for my current practice, and how to adapt and add other theories into my practice as I see fit. I have discovered that Dorothea Orem’s Self-Care Deficit Nursing Theory is the most applicable to my current nursing practice. However, if I were to change fields, a different theory might be better for guiding my practice. This will also hold true as I become a Nurse Practitioner. What I use Registered Nurse may not work best for an Advanced Practice Nurse. I also learned that all nursing practice is based on nursing theories and philosophies that have advanced over time. Theories from hundreds of years ago can still be applied to nursing today, and as nursing has advanced over time, new nurses have developed modern theories to apply to the ever-changing situations nurses encounter.

References

McEwen, M. (2014). Overview of theory in nursing. In M. McEwen & E. M. Wills (Eds.), Theoretical basis for nursing (4th ed., pp. 23–48). Lippincott Williams & Wilkins. https://zu.edu.jo/UploadFile/Library/E_Books/Files/LibraryFile_171030_28.pdf

Saleh, U. S. (2018). Theory guided practice in nursing. Journal of Nursing Research Practice, 2(1), 18. https://www.pulsus.com/scholarly-articles/theory-guided-practice-in-nursing.pdf

Discussion Board 7.1 Theory, Practice, and Philosophy of Nursing

The statement, “Theory must be a guide to practice, not an end in itself,” has significant meaning to me. Nursing theory-guided practice is very important in the clinical setting, but it should be driven by the unique patient condition. As a nurse, we have to take all aspects of the patient into consideration when implementing theory-guided practice. We cannot disregard any patient condition or considerations just to make a certain theory or metaparadigm fit into our nursing practice. Younas and Quennell identify the importance of using nursing theory-guided practice over traditional practice in an article that they published. They did an analysis of literature including over twenty-six articles that proved nursing theory-guided interventions to be the most effective (Younas & Quennell, 2019). I believe that nursing theory is extremely significant in our everyday nursing practice while still keeping individualities of the patient’s condition and illness in consideration.

In the discussion board post for the first week of this course, I identified my personal tenets of nursing to include being compassionate, honest, and caring. I also strived to provide nursing care that was holistic and be an advocate for all of my patients. After studying nursing theories and continuing my practice as a nurse, my tenets have slightly changed over the past few weeks. While being an advocate for my patients and providing holistic care for my patients is still some of my main priorities as a nurse, I have identified a few more priority actions to my nursing care. Another tenet that I have added to my personal philosophy of nursing includes providing safe, individualized, and educated care to my patients. I strive to be a lifelong learner as a nurse. My tenets have slowly changed due to the environment and department that I work in. I have been working under conditions where nurses are not put in the safest situations.

I have been working in situations where the nurses have not received the proper education for the positions that they have been put in. Personally, I strive to educated and provide safe, effective, and quality care to every patient that I take care of in my practice. In an article by Vaismoradi et al. (2020), the numerous personal aspects of nurses were determined to affect and influence how closely safety protocols were followed in regard to patient care. These personal aspects include the nurse’s knowledge, perceptions, and their attitude towards patient care (Vaismoradi et al., 2020). Overall, my patient care is influenced by all of the tenets that I have described in the beginning of this course and now. This course and the study of theories has only helped develop my nursing practice and philosophy to be even stronger.

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References

Vaismoradi, M., Tella, S., A Logan, P., Khakurel, J., & Vizcaya-Moreno, F. (2020). Nurses’ adherence to patient safety principles: A systematic review. International Journal of Environmental Research and Public Health, 17(6), 1-10. https://doi.org/10.3390/ijerph17062028 (Links to an external site.)

Younas, A., & Quennell, S. (2019). Usefulness of nursing theory‐guided practice: an integrative review. Scandinavian Journal of Caring Sciences, 33(3), 540–555. https://doi- org.ezproxy.bradley.edu/10.1111/scs.12670

Theory, Practice, and Philosophy of Nursing

My perception to the statement “Theory must be a guide to practice, not an end in itself” is that A theory is starting point, most theories are fairly broad and general in topic. The theorists develops their idea pertaining to the time period in which they live, and they environment they are most comfortable with. Many things change in healthcare daily, evidence-based practice and new studies change how we should do things daily, so not compensating for those changes could be detrimental to a nurse’s skill set (Saleh, 2017). For instance, the basis of Florence Nightingale’s theory of nursing has been a profound building block in how we, as nurses, provide care for our patients, but the nursing environment has changed immensely from the time she was caring for patients (Nibbelink & Brewer, 2018). Her theories and ideas for nursing care are and forever will bet highly regarded in the world of healthcare, but as with many nursing theories, the ideas must be further evaluated to fit into the individual case. Nursing theories must be developed further to fit a more distinct area or timeline (Nibbelink & Brewer, 2018).

A theory may be incredibly helpful to a situation the nurse is handling, but it may be missing vital information related to the situation at hand, the nurse must tweak some of the parts of the theory to make it work for her situation. Theories are simply a starting point for a plan, and must be updated or molded to fit particular situations. Even in the article in the required reading, it states that a theory was started, but all the vital pieces aren’t there yet. That the theory discussed has been added to, has been modified, and updated, but the link between nurse and environment still hasn’t been made (Bender & Feldman, 2015). Anyone who has worked in healthcare knows the link is a vital one, and directly effects the nurses ability to give their best care to their patients. I perceive the statement to be, nursing theories are a starting point or a beginning, they must be modified to fit each specific situation and should be studied further.

After reviewing, studying, and learning so many theories the last several weeks, I believe my tenets have been strengthened. The first week of this class, I was asked to identify three beliefs that are the most important to me regarding my role in nursing. This was a bit of challenge for me to put into three words, or brief statements, because there is so much about nursing that is important to me, but these few weeks have helped me condense so many things into these simple words. My three words that are the biggest tenets for me are empathy, justice, and knowledge. These were so difficult for me at the beginning of class, because I felt these simple words weren’t inclusive enough, at this time I feel like they each carry more weight. Empathy, is not a simple feeling. Feeling bad for someone is not empathy, showing sympathy for someone is not empathy. Empathy is the ability to put yourself in one’s situation to the best of your ability. It is know what is the best way to comfort a person, without making them feel uncomfortable or pitied.

In my opinion, empathy is the single most important tool a nurse can have when caring for any type of patient. This belief has not changed at all, and is probably stronger than ever. Even in the moments of compassion fatigue, or being overworked, a nurse can gain extreme wealths on knowledge about their patient by showing empathy. Justice, may second tenet. I think the word justice in this context has actually expanded exponentially. When I first spoke about justice, in this class, I meant mostly to treat each patient as a person. Unfortunately, there is still a lot of prejudice in this world, and a different set in healthcare. My original statement was simply about the treatment of patients regardless of color, race, cultural beliefs, religion, diagnosis, and/or illness. This is still a huge belief for me, and I will advocate these things for any patient I may encounter, but my feelings have expanded to the treatment and justice for nurses, as well. I have actually been contemplating how I can help fight for the justice of nurses, too. Thirdly, knowledge is something that can never be taken away from a person. The knowledge a nurse gains from books and experiences is a wonderful tool, but the knowledge a nurse can gain from their patient is an asset. There is no greater help for a nurse than the knowledge they can gain from the patient they are caring for. My tenets have not swayed, or changed, they have probably expanded, because of the knowledge I have gained in this class.

Nibbelink, C. W., & Brewer, B. B. (2018). Decision-making in nursing practice: An integrative literature review. Journal of clinical nursing, 27(5-6), 917–928. https://doi.org/10.1111/jocn.14151 (Links to an external site.)

Saleh, U. S. (2018). Theory guided practice in nursing. Journal of Nursing Research Practice, 2(1), 18. https://www.pulsus.com/scholarly-articles/theory-guided-practice-in-nursing.pdf (Links to an external site.)

Bender, M. and Feldman, M. S. (2015.) A practice theory approach to understanding the interdependency of nursing practice and the environment (PDF). Advances in Nursing Science, 38(2), 96–109.

Edited by Airion Bollenbaugh on Oct 5, 2021 at 11:13am

The statement “Theory must be a guide to practice, not an end in itself” refers to the applicability of theory to practice. Theories can originate from situational cases or conceptual ideas. It is important to consider the relevancy a specific nursing theory will have to nurses in their everyday practice, especially if the theory does not stem from clinical practice. Nursing theory must have an intention for a result. Theories should help guide nurses in their clinical practice to improve patient outcomes and increase patient safety. For example, a study analyzed three theories and how they impacted nurse’s decision-making abilities when a patient has a myocardial infarction with an elevated ST-segment (Watkins, 2020). The study showed how each theory influenced patient care and determined a prescriptive theory was critical for deciding the next course of action (Watkins, 2020). Throughout this course, I have mentally assessed how each theory could persuade my current clinical practice. I use my previous nursing experience when learning about some theories knowing they are suitable for a different clinical setting. An example is Story Theory by Patricia Liehr and Mary Jane Smith is more relevant in my role at an outpatient dermatology clinic versus a perioperative nurse. The statement about theory guiding practice highlights the purpose of theory is for action.

I identified my personal philosophy of nursing as collaboration, advocacy, and respect. It was interesting to go back and read my initial thoughts from week 1 compared to now. I still agree with my original beliefs of collaboration, advocacy, and respect. I just have new perspective on all these ideals through the lens of nursing theory. I analyze the ways my beliefs align with theories we have studied and hypothesize the outcomes if a theory were to directly explore my beliefs. For example, Duffy’s Quality Care model emphases the personal relationship created between patient and nurse throughout care directly effects patient’s perception of care (O’Nan et al., 2014). Duffy’s Quality Care model was used in a study to analyze patient perception of nursing care in a community hospital setting to identify level of caring compassion (O’Nan et al., 2014). The tenet in Duffy’s model is quality care and can be empirically tested for results through research. This course taught be to look at my beliefs more holistically and see how they can be implemented throughout my nursing practice. I believe respect, collaboration, and advocacy are presented and important to most clinical settings. My nursing philosophy is the foundation for my personal practice and executing these values make me a better nurse for my patients.

References

Watkins, S. (2020). Effective decision-making: applying the theories to nursing practice. British Journal of Nursing, 29(2), 98–101. https://doi-org.ezproxy.bradley.edu/10.12968/bjon.2020.29.2.98

O’Nan, C. L., Jenkins, K., Morgan, L. A., Adams, T., & Davis, B. A. (2014). Evaluation of Duffy’s Quality Caring Model© on Patients’ Perceptions of Nurse Caring in a Community Hospital. International Journal for Human Caring, 18(1), 27–34. https://doi-org.ezproxy.bradley.edu/10.20467/1091-5710-18.1.27

Theory Guided Practice

A theory is used as a continuous guide to practice because it defines a specific domain’s variables, relationships, and predictions. Theory guides the transition of research to propel changes into current practice (Nilsen, 2015). I interpret the statement of “Theory must be a guide to practice, not an end in itself” as theory is a progressive discipline that requires continuous study in practice. Using it as a guide can further the development of future theory. According to Smith (2020), theories help us process our experiences, generate meaning from those experiences, and ask questions that lead to new insights. Because each patient, shift, and nursing action may differ during our practice, it is important to apply multiple theories in our practice. Throughout our practice, we may use theory both informally and formally. We may combine grand theories and middle-range theories, or we may currently use some aspects and not use others. When theory is implemented, and we allow it to guide our practice, it helps design and implement interventions that generate successful patient outcomes. When theory is failed to be used, it inhibits the ability to identify the source of a problem and creates barriers to future theory development (Davidoff et al., 2015).

After diligent research of theory and theory-guided practice, the three tenets of my nursing philosophy of empathy, communication, and advocacy have not changed. Empathy, communication, and advocacy are demonstrated throughout every nursing theory we have studied. These three tenets apply to my current and future practice. As a healthcare provider, effective communication provides greater accuracy in diagnosis, promotes patient involvement in care, decreases the likelihood of malpractice, and improves outcomes (Howick et al., 2018). In addition, I maintain a strong belief that maintaining open communication with an individual develops trust, fosters patient empowerment, and creates an environment for proper healing. The implementation of theory-guided nursing practice requires quality communication in all aspects of implementation. Being able to understand how a patient is feeling and what they are experiencing affects if a theory is able to be successfully implemented. Demonstrating an empathetic attitude fosters the success of a theory intervention. The study of theory has reinforced my belief that advocacy is essential to nursing practice. Advocacy is present through the implementation of theory by continuous research and reflection of current practices to guide patient safety and improve clinical outcomes. I will continue to use theory to improve my strengthen my philosophy and improve my current practice.

References:

Davidoff, F., Dixon-Woods, M., Leviton, L., & Michie, S. (2015). Demystifying theory and its use in improvement. BMJ quality & safety, 24(3), 228–238. https://doi.org/10.1136/bmjqs-2014-003627 (Links to an external site.)

Howick, J., Moscrop, A., Mebius, A., Fanshawe, T. R., Lewith, G., Bishop, F. L., Mistiaen, P., Roberts, N. W., Dieninytė, E., Hu, X. Y., Aveyard, P., & Onakpoya, I. J. (2018). Effects of empathic and positive communication in healthcare consultations: a systematic review and meta-analysis. Journal of the Royal Society of Medicine, 111(7), 240–252. https://doi.org/10.1177/0141076818769477 (Links to an external site.)

Nilsen P. (2015). Making sense of implementation theories, models, and frameworks. Implementation science : IS, 10, 53. https://doi.org/10.1186/s13012-015-0242-0 (Links to an external site.)

Smith, M. C. (2020). Nursing theories and nursing practice (5th ed.). F.A. Davis.